Objective: Transcatheter aortic valve implant (TAVI) is the gold standard for the high-surgical-risk group of patients with aortic valve disease and it is an alternative to surgery in patients at intermediate risk. Lethal complications can occur, and many of these are manageable only with emergent conversion to open heart surgery. We retrospectively evaluate the outcome of all patients undergoing TAVI in our departments and the impact of a complete cardiac rescue team to reduce 30-day mortality. Methods: Data from all patients undergoing TAVI between January 2020 and August 2023 in our center were analyzed. An expert complete rescue was present in catheter laboratory. Primary outcomes were in-hospital and at 30-day mortality and evaluation of all cases needed for emergent conversion to open heart surgery. Results: 825 patients were enrolled. The total mortality was 19/825 (2.3%). Eleven of the total patients (1.3%) required emergent conversion to open heart surgery. Among them, eight were alive (73%), with a theoretical decrease of 0.98% in overall mortality. Conclusions: surgical treatment is rare during TAVI. The presence of an expert complete rescue team as support means an increase in survival. Surgery must be used only to restore circulatory and to treat complication while percutaneous approaches should complete the procedure.

Background. The in-hospital reduction in low-density lipoprotein cholesterol (LDL-C) levels following acute coronary syndrome (ACS) is recommended in the current clinical guidelines. However, the efficacy of proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors in those patients undergoing coronary artery bypass graft (CABG) has never been demonstrated. Methods. From January 2022 to July 2023, we retrospectively analyzed 74 ACS patients characterized by higher LDL-C levels than guideline targets and who underwent coronary bypass surgery. In the first period (January 2022–January 2023), the patients increased their statin dosage and/or added Ezetimibe (Group STEZE, 43 patients). At a later time (February 2023–July 2023), the patients received not only statins and Ezetimibe but also Evolocumab 140 mg every 2 weeks starting as early as possible (Group STEVO, 31 patients). After one and three months post-discharge, the patients underwent clinical and laboratory controls with an evaluation of the efficacy lipid measurements and every adverse event. Results. The two groups did not differ in terms of preoperative risk factors and Euroscore II (STEVO: 2.14 ± 0.75 vs. STEZE: 2.05 ± 0.6, p = 0.29). Also, there was no difference between the groups in terms of ACS (ST-, Instable angina, or NSTE) and time of symptoms onset regarding total cholesterol, LDL-C, and HDL-C trends from the preprocedural period to 3-month follow-up, but there was a more significant reduction in LDL-C and total cholesterol in the STEVO group (p = 0.01 and p = 0.04, respectively) and no difference in HDL-C rise (p = 0.12). No deaths were reported. In three STEZE group patients, angina recurrence posed the need for percutaneous re-revascularization. No STEVO patients developed significant adverse events. The statistical difference in these serious events, 7% in STEZE vs. 0% in STEVO, was not significant (p = 0.26). Conclusions. Evolocumab initiated “as soon as possible” in ACS patients submitted to CABG with high-intensity statin therapy and Ezetimibe was well tolerated and resulted in a substantial and significant reduction in LDL-C levels at discharge, 1 month, and 3 months. This result is associated with a reduction but without a statistical difference between groups.

Background: The inhibition of PCSK9 lowered LDL cholesterol levels, reducing the risk of cardiovascular events. However, the effect on patients who have undergone surgical myocardial revascularization has not yet been evaluated. Methods: From January 2017 to December 2022, 180 dyslipidemic patients who underwent coronary artery bypass were included in the study. Until December 2019, 100 patients optimized therapy with statin ± ezetimibe (SG). Since January 2020, 80 matched patients added treatment with Evolocumab every 2 weeks (EG). All 180 patients were followed-up at 3 and 12 months, comparing outcomes. Results: The two groups are homogenous. At 3 months and 1 year, a significant decrease in the parameter mean levels of LDL cholesterol and total cholesterol is detected in the Evolocumab group compared to the standard group. No mortality was detected in either group. No complications or drug discontinuation were recorded. In the SG group, five patients (5%) suffered a myocardial infarction during the 1-year follow-up. In the EG group, two patients (2.5%) underwent PTCA due to myocardial infarction. There is no significant difference in overall survival according to the new treatment (p-value = 0.9), and the hazard ratio is equal to 0.94 (95% C.I.: [0.16–5.43]; p-value = 0.9397). Conclusions: The use of Evolocumab, which was started immediately after coronary artery bypass graft surgery, significantly reduced LDL cholesterol and total cholesterol levels compared to statin treatment alone and is completely safe. However, at one year of follow-up, this result did not have impact on the reduction in major clinical events.

Background: Convergent epicardial and endocardial catheter ablation had been used for the treatment of persistent atrial fibrillation (PeAF). Aims: The aims of this retrospective study are to describe the pattern of arrhythmias and substrate findings in patients previously submitted to convergent ablation and showing arrhythmic recurrences (AF/AT/AFL lasting at least 30 seconds) and documented with ILR during follow up. Methods: From a cohort of 119 patient who underwent convergent ablation, we selected the 55 with arrhythmic recurrences and showing AT/AF/AFL stored in ILR memories to submit them to remap procedure. Results: We excluded 1 patient who was submitted to ablate and pace without remapping and 1 patient whose data has been lost. Among 53 patients, 69.7% experienced AF (33.9% PAF and 35.8% PeAF), 5.6% typical AFL and 30.2% AT/atypical AFL. As for the substrates found, at detailed high-density mapping we had: 66.9% with veins reconnection (regardless the gaps localization), 37.7% with low-voltage area/abnormal signals on the posterior wall, 11.3% deserving CTI ablation for typical AFL and 28.3% with different LA substrates (septal, anterior, LAA, mitral annulus and 9.4% with gaps at superior surgical line). Notably, overlaps of arrhythmic patterns and substrate were also found in the same patients. Conclusion: In our study a total of 79.1% patients had substrates related to previous convergent ablation due to gaps at pulmonary veins or superior line. The rest had an arrhythmic substrate in areas not previously ablated like posterior wall or CTI. These findings suggest that a large amount of patients submitted to convergent ablation (up to 80%) may have an arrhythmic substrate and thus potentially recurrences due to previous epi-endocardial ablation.

Background and Objectives: ICD implantation is associated with psychological distress, but longitudinal patterns of anxiety and depression remain incompletely characterized. To evaluate the prevalence and longitudinal evolution of anxiety and depressive symptoms in patients undergoing first-time ICD implantation. Materials and Methods: This prospective study included 96 patients undergoing first ICD implantation. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) at implantation (T0), one week post-discharge (T1), and six months later (T2). Data distribution was assessed using the Shapiro–Wilk test. Changes over time were analyzed using the Friedman test, Wilcoxon signed-rank tests, and Linear Mixed-Effects Models (LMM), with effect size (Kendall’s W) and Spearman correlations. A sensitivity analysis evaluated severe distress thresholds (HADS ≥ 11). Results: Significant longitudinal changes were observed for both anxiety (Friedman Q = 63.32, p < 0.001; Kendall’s W = 0.34) and depression (Q = 68.36, p < 0.001; W = 0.37). Mean HADS-A scores increased from 7.40 ± 2.70 at T0 to 9.22 ± 3.35 at T1 and 8.55 ± 2.78 at T2. Mean HADS-D scores increased from 6.53 ± 2.47 to 8.06 ± 3.02 and 8.24 ± 2.41, respectively. Clinically relevant anxiety (HADS-A ≥ 8) increased from 41.7% to 66.3% and 58.7%, while clinically relevant depression (HADS-D ≥ 8) increased from 27.1% to 54.3% and 56.5%. Sensitivity analyses for severe cases (HADS ≥ 11) confirmed consistent temporal trajectories (p < 0.001). Subgroup analyses (sex, indication, age) revealed no significant differences (p > 0.15), and no ICD shocks were delivered during follow-up. Anxiety and depression were strongly correlated at all time points (p < 0.001). Conclusions: Anxiety and depression symptoms are highly prevalent among ICD recipients and follow distinct temporal trajectories during the post-implantation course, with anxiety peaking early and depressive symptoms showing a more sustained increase in the absence of device therapies. Routine psychological screening and stage-specific psychosocial support strategies should be evaluated for integration into standard ICD care.